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Evaluation and diagnosis of common causes of foot pain in adults

Karl B Fields, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Foot pain is a common problem among adults. According to the Framingham population study of older adults, approximately 19 percent of men and 25 percent of women have significant foot pain on most days of the week that often limits their ability to function [1]. The authors of this study recommend that clinicians include a foot examination as part of their routine evaluation of older patients. However, many clinicians may not be adequately prepared to perform such an examination as their training in the diagnosis and care of foot problems is limited [2].

This topic reviews the common causes of foot pain in adult patients, including the frequency of problems in specific populations. Conditions are organized by location, including the forefoot, midfoot, and rear foot. Examination focuses on visual inspection of the foot. The appearance of many common foot conditions can lead the clinician to the correct diagnosis. A detailed approach to the diagnosis of forefoot pain is provided separately. (See "Evaluation and diagnosis of common causes of forefoot pain in adults".)


Certain populations appear to be at increased risk of developing foot pain. These include: older adults, the obese, active adults who participate in sports that involve running and jumping, active military personnel, and those engaged in certain occupations [3-7].

In a multiethnic sample of 784 community dwelling adults older than 65 years, 30.9 percent had tenderness to palpation of the foot. In addition, minor foot disorders affected the majority of individuals, including toenail disorders (74.9 percent), minor toe deformities (60 percent), corns and calluses (58.2 percent), and bunions (37.1 percent). Skin problems, including fungal infection, cracking, maceration between toes, and minor cuts, affected greater than one-third of individuals. Gender differences were noted, with women having greater problems with bunions, corns, and calluses. In addition, racial and ethnic differences were noted for flat feet, corns and calluses, toe disorders, and other physical findings, although additional studies would be needed to clarify these findings [3].

Several studies document a significant burden of disability and impaired quality of life among middle aged and older adults with foot pain. In a meta-analysis of 31 studies including 75,505 participants, 24 percent experienced frequent foot pain [4]. Forefoot pain was most common and women appeared affected more frequently than men. In affected individuals, two-thirds reported moderate disability secondary to this pain. In an older cohort of 301 community-dwelling patients aged 70 to 95 years, 36 percent reported disabling foot pain; foot pain had a strong association with depression and low well-being scores on a standardized symptom inventory [5].

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Literature review current through: Dec 2017. | This topic last updated: Jul 31, 2017.
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  1. Menz HB, Dufour AB, Casey VA, et al. Foot pain and mobility limitations in older adults: the Framingham Foot Study. J Gerontol A Biol Sci Med Sci 2013; 68:1281.
  2. Clawson DK, Jackson DW, Ostergaard DJ. It's past time to reform the musculoskeletal curriculum. Acad Med 2001; 76:709.
  3. Dunn JE, Link CL, Felson DT, et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004; 159:491.
  4. Thomas MJ, Roddy E, Zhang W, et al. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain 2011; 152:2870.
  5. Menz HB, Tiedemann A, Kwan MM, et al. Foot pain in community-dwelling older people: an evaluation of the Manchester Foot Pain and Disability Index. Rheumatology (Oxford) 2006; 45:863.
  6. O'Kane JW, Levy MR, Pietila KE, et al. Survey of injuries in Seattle area levels 4 to 10 female club gymnasts. Clin J Sport Med 2011; 21:486.
  7. Pearce CJ, Brooks JH, Kemp SP, Calder JD. The epidemiology of foot injuries in professional rugby union players. Foot Ankle Surg 2011; 17:113.
  8. Kaplan LD, Jost PW, Honkamp N, et al. Incidence and variance of foot and ankle injuries in elite college football players. Am J Orthop (Belle Mead NJ) 2011; 40:40.
  9. Campoy FA, Coelho LR, Bastos FN, et al. Investigation of risk factors and characteristics of dance injuries. Clin J Sport Med 2011; 21:493.
  10. Nwawka OK, Hayashi D, Diaz LE, et al. Sesamoids and accessory ossicles of the foot: anatomical variability and related pathology. Insights Imaging 2013; 4:581.
  11. Cass AD, Camasta CA. A review of tarsal coalition and pes planovalgus: clinical examination, diagnostic imaging, and surgical planning. J Foot Ankle Surg 2010; 49:274.
  12. Giuffra V, Bianucci R, Milanese M, et al. A case of brachymetatarsia from medieval Sardinia (Italy). Anat Rec (Hoboken) 2014; 297:650.
  13. Robinson JF, Ouzounian TJ. Brachymetatarsia: congenitally short third and fourth metatarsals treated by distraction lengthening--a case report and literature summary. Foot Ankle Int 1998; 19:713.
  14. Froehlich V, Wuenschel M. A rare combination of brachymetatarsia and congenital hallux varus: case report and review of the literature. J Am Podiatr Med Assoc 2014; 104:85.
  15. Jenkins DW, Cooper K, O'Connor R, et al. Prevalence of podiatric conditions seen in Special Olympics athletes: Structural, biomechanical and dermatological findings. Foot (Edinb) 2011; 21:15.
  16. Hillstrom HJ, Song J, Kraszewski AP, et al. Foot type biomechanics part 1: structure and function of the asymptomatic foot. Gait Posture 2013; 37:445.
  17. Mootanah R, Song J, Lenhoff MW, et al. Foot Type Biomechanics Part 2: are structure and anthropometrics related to function? Gait Posture 2013; 37:452.
  18. Di Caprio F, Buda R, Mosca M, et al. Foot and lower limb diseases in runners: assessment of risk factors. J Sports Sci Med 2010; 9:587.
  19. Rouvreau P, Pouliquen JC, Langlais J, et al. [Synostosis and tarsal coalitions in children. A study of 68 cases in 47 patients]. Rev Chir Orthop Reparatrice Appar Mot 1994; 80:252.
  20. Lee WC, Yi Y. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon. Orthopedics 2014; 37:467.
  21. Chuang YW, Tsai WS, Chen KH, Hsu HC. Clinical use of high-resolution ultrasonography for the diagnosis of type II accessory navicular bone. Am J Phys Med Rehabil 2012; 91:177.
  22. Potter NJ, Brukner PD, Makdissi M, et al. Navicular stress fractures: outcomes of surgical and conservative management. Br J Sports Med 2006; 40:692.
  23. Khan KM, Fuller PJ, Brukner PD, et al. Outcome of conservative and surgical management of navicular stress fracture in athletes. Eighty-six cases proven with computerized tomography. Am J Sports Med 1992; 20:657.
  24. Kobayashi H, Sakurai M, Kobayashi T. Extensor digitorum longus tenosynovitis caused by talar head impingement in an ultramarathon runner: a case report. J Orthop Surg (Hong Kong) 2007; 15:245.
  25. Hetsroni I, Mann G, Ayalon M, et al. Extensor digitorum longus tendonitis in windsurfing due to footstrap fixation. Clin J Sport Med 2006; 16:74.
  26. Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes 2011; 2:59.
  27. Gaweda K, Tarczyńska M, Modrzewski K, Turzańska K. An analysis of pathomorphic forms and diagnostic difficulties in tarso-metatarsal joint injuries. Int Orthop 2008; 32:705.
  28. Adams E, Madden C. Cuboid subluxation: a case study and review of the literature. Curr Sports Med Rep 2009; 8:300.
  29. Macdonald DJ, Holt G, Vass K, et al. The differential diagnosis of foot lumps: 101 cases treated surgically in North Glasgow over 4 years. Ann R Coll Surg Engl 2007; 89:272.
  30. Fausto de Souza D, Micaelo L, Cuzzi T, Ramos-E-Silva M. Ledderhose disease: an unusual presentation. J Clin Aesthet Dermatol 2010; 3:45.
  31. Aranda Y, Munuera PV. Plantar fasciitis and its relationship with hallux limitus. J Am Podiatr Med Assoc 2014; 104:263.
  32. Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg 2014; 20:160.
  33. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund's deformity. Foot Ankle Int 2012; 33:487.
  34. Paavola M, Kannus P, Järvinen TA, et al. Achilles tendinopathy. J Bone Joint Surg Am 2002; 84-A:2062.
  35. Kedia M, Williams M, Jain L, et al. The effects of conventional physical therapy and eccentric strengthening for insertional achilles tendinopathy. Int J Sports Phys Ther 2014; 9:488.
  36. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 2004; 86-A:916.
  37. Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int 2007; 28:1064.
  38. Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am 2010; 92:2604.
  39. Niek van Dijk C. Anterior and posterior ankle impingement. Foot Ankle Clin 2006; 11:663.
  40. Helgeson K. Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther 2009; 4:29.
  41. Lee KB, Bai LB, Park JG, et al. Efficacy of MRI versus arthroscopy for evaluation of sinus tarsi syndrome. Foot Ankle Int 2008; 29:1111.
  42. Lee KB, Bai LB, Song EK, et al. Subtalar arthroscopy for sinus Tarsi syndrome: arthroscopic findings and clinical outcomes of 33 consecutive cases. Arthroscopy 2008; 24:1130.
  43. Dienst M, Blauth M. Bone bruise of the calcaneus. A case report. Clin Orthop Relat Res 2000; :202.
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